March 29, 2010

Over the weekend, the practice website www.FauquierENT.net underwent a very painful and time-consuming move to a new Linux server. In the past, the website was hosted on a WebDAV server (.Mac). However, the website had outgrown this home due to the amount of traffic it has been receiving (close to 5000 hits a day now).

As such, after almost 2 days of setting up the new server, transferring all the files, updating links, and creating forwarding addresses of all the webpages on the old server, we THINK the website has remained operational without any downtime.

There may be a few snafus here and there during the move that we haven't caught yet, but with time, these should all be ironed out.

March 23, 2010

I have recently seen a rash of patients who have a presenting symptom of a sense of mucus or phlegm buildup in the back of the mouth/nose right behind the soft palate after surgery involving uvula removal. Such surgery may include the uvula alone or UPPP (uvulopalatopharyngoplasty) for obstructive sleep apnea.

Often in these cases, this problem with mucus and phlegm is due to a very small velopharyngeal insufficiency. This is a rare problem where there is a small opening between the palate and nose when swallowing causing a little bit of saliva to "regurgitate" into the nose. If the opening is very large, liquids and even food will come out the nose when swallowing. If it is very small, mucus/phlegmy sensation will be present localized to the area right behind the soft palate.

This problem, if present, can be corrected by a simple procedure called nasopharyngoplasty.

March 22, 2010

It was with great interest that I read a recent report that a new drug, Silenor, was approved by the FDA this month (March 18, 2010) to help people who have trouble sleeping. Although there are already prescription medications to help with sleep (Ambien and Lunesta being the most common ones), Silenor is very interesting in that there was no suggestion of any addictive properties or withdrawal with this medication in over 1000 patients during clinical trials.

In fact, Silenor has not been designated as a controlled substance by the U.S. Drug Enforcement Administration (DEA) because of its demonstrated lack of abuse potential. Ambien and Lunesta are both considered as controlled substances.

Silenor binds with high affinity to the histamine H1 receptor... the same receptor that over-the-counter benadryl attaches to resulting in a side-effect of drowsiness. BUT, Silenor attaches to this receptor 14X more strongly compared to benadryl.

March 18, 2010

Patients may have noticed that the Epi-Pen now looks different. The "old" epipen was completely circular with grey safety and black cap.

The new epipen has a blue safety and an auto-injector orange cap that automatically expands to cover the needle after use to prevent accidental needle stick. Also, the instructions on use is much easier to read as the shape of the epipen is oblong instead of circular. Much better overall design in my mind!

All our patients on allergy shots are given epipen to have on hand in case of anaphylactic reaction.

Two signs that a patient has mal de debarquement are if they feel a rocking sensation for weeks or months starting after a cruise and if they're fine when driving but not when standing, walking or sitting.

March 14, 2010

The LA Times on March 15, 2010 published a story entitled "Are neti pots on the nose?". The story describes the effectiveness of regular saline flushes to the nose in reducing as well as preventing allergy symptoms, colds, and sinus infections. Devices that can flush the nose/sinus include Neti-Pots as well as Neilmed Sinus Rinse. Electronic devices also exist (see below).

March 12, 2010

Researchers at Vanderbilt and Harvard University have determined that short-term hearing deprivation during childhood may lead to persistent hearing deficits, long after hearing is restored to normal. Their research published in the March 11 issue of Neuron revealed that in rats, a "lazy ear" can develop when balanced auditory signals are not transmitted from each ear to the brain during a critical period for auditory cortex development.

In humans, "an analogous problem may exist ... in that children commonly experience a buildup of viscous fluid in the middle ear cavity, called otitis media with effusion, which can degrade the quality of acoustic signals reaching the brain and has been associated with long-lasting loss of auditory perceptual acuity," explains senior study author, Dr. Daniel Polley from the Massachusetts Eye and Ear Infirmary.

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